What is Hot Flashes?
Hot flashes are sudden feelings of warmth that can instantly appear and frequently happen. These warm sensations are usually felt in the chest, neck, and face and are often followed by sweating. This condition is the main reason women seek medical attention when going through perimenopause, particularly when these symptoms negatively affect their daily lives. Along with hot flashes, a woman may experience sweating, a racing heart, headaches, weakness, fatigue, dizziness, and anxiety. Triggers for hot flashes can include warm surroundings, hot beverages, or emotional stress.
It’s important to note that hot flashes can vary greatly in terms of how long they last, how severe they are, and how often they occur. Their frequency and intensity can increase during the transition to menopause, reaching their highest point about a year after a woman’s final menstrual period. Hot flashes can continue for anywhere from 6 months to several years, but they typically become less frequent and less intense over time after the cessation of menstrual periods.
On average, each hot flash lasts less than 5 minutes. The average frequency can range from happening 10 times a day to several times a week. On average, hot flashes last for about 1.2 years.
What Causes Hot Flashes?
While scientists aren’t completely sure why hot flashes happen, research suggests they come about because of a problem in the part of the body that controls our internal temperature (this is known as a central thermoregulatory function defect).
We know quite a lot about the physical changes that come with hot flashes, but there are a few theories about why these changes happen. Several hormones and neurotransmitters (these are like little messengers that help the cells in our bodies communicate) play a part in hot flashes, but estrogen seems to be the most important. It’s believed that hot flashes might start when the ovaries stop producing as much estrogen.
Hot flashes might also involve two other neurotransmitters – norepinephrine and serotonin. This idea comes from the fact that medications known as SSRIs and SNRIs — which effect these neurotransmitters — have been used to treat hot flashes.
Research has also found that the levels of norepinephrine metabolites (these are substances produced when our body breaks down norepinephrine) in the blood increase just before and during a hot flash. This process can cause the blood vessels on the surface of the body to widen, especially in the fingers and toes causing them to increase in temperature by 10 to 15 degrees Celsius.
During a hot flash, one’s systolic blood pressure (the pressure in your arteries when your heart beats) and heart rate can also increase.
Risk Factors and Frequency for Hot Flashes
Hot flashes are one of the most frequent symptoms related to changes in blood vessels during menopause, affecting up to 74% of women going through this change in life. 65% of women experience hot flashes for more than 2 years, and 36% suffer from them for over 5 years.
Signs and Symptoms of Hot Flashes
All women going through perimenopause should be checked for hot flashes. Treatment for hot flashes is necessary if these flashes are affecting a woman’s daily life activities and sleep. However, many women experience hot flashes and do not require any treatment. In severe cases, hot flashes can cause a woman to wake up multiple times during the night. Over time, this can lead to cognitive and anxiety disorders.
Treatment Options for Hot Flashes
While a number of treatment options exist for dealing with symptoms of menopause such as hot flashes, not all of these treatments have been approved by the FDA. Your healthcare provider should guide you towards the safest solutions first. These might include making changes in your lifestyle, before moving on to hormonal or non-hormonal treatments.
The most effective treatment for hot flashes usually involves taking systemic estrogen, which can decrease the frequency of these symptoms by 75%. However, this might not be a suitable solution for everyone. Certain high-dose progestin therapies could be an alternative for women who can’t take estrogen. Hormone therapy, or HT, which helps manage these symptoms, can be administered in various forms – oral, injectable, topical, vaginal, or by a patch.
The Women’s Health Initiative, or WHI, conducted the largest study looking at the risks associated with hormone therapy in menopausal women. The study found that combined HT might increase the incidence of breast cancer, thromboembolic events, and stroke. Therefore, HT is typically recommended for treating moderate to severe menopause symptoms at the lowest effective dose.
An alternative to conventional HT are ‘compounded bioidentical hormones’; however, there isn’t enough evidence to suggest that these are as safe or effective. Therefore, healthcare professionals often turn to other methods for managing menopause symptoms.
Several over-the-counter, non-hormonal therapies have been studied, including soy extract, red clover isoflavones, black cohosh, and Chinese herbs. However, the safety and efficacy of these therapies remain unclear. Prescription non-hormonal therapies are available but they are generally not as effective as hormonal therapy. These include medications such as Gabapentin/pregabalin, Clonidine, SSRIs like Paroxetine, and SNRIs like Venlafaxine and Desvenlafaxine.
Paroxetine was the first non-hormonal prescription medication to be FDA-approved for managing menopausal hot flashes. However, it and other SSRIs are not recommended for use with women experiencing hot flashes due to tamoxifen, a medication used for breast cancer treatment as they can interfere with its therapeutic benefit. Women on tamoxifen can manage their hot flashes with SNRIs like Venlafaxine instead.
Lifestyle modifications such as exercising, wearing layered clothes, maintaining a cooler room temperature, drinking cool beverages, and avoiding caffeine and alcohol are also suggested when managing menopause symptoms. While there’s a lack of conclusive studies proving their efficacy, these changes are generally considered safe and logical.
In terms of alternative therapies, the field of integrative medicine is exploring options such as breathing exercises, relaxation techniques, changes in diet, yoga, acupuncture, reflexology, and hypnosis to relieve symptoms of menopause. Unfortunately, there’s a shortage of comprehensive studies examining these, but research in this area is growing.
What else can Hot Flashes be?
Hot flashes are mostly linked with the period leading up to and including menopause. Women experiencing hot flashes, whether they are nearing menopause age, or have undergone surgical or medically induced menopause, should be checked to ensure these symptoms are not due to a disease or condition. Menopause can be confirmed if a woman hasn’t had a period for at least 12 months and through certain hormone levels (estradiol and FSH levels).
There are several conditions that might cause hot flashes, besides menopause. These include:
- Carcinoid tumors
- Systemic mastocytosis
- Medullary carcinoma of the thyroid
- Pheochromocytoma
- Hyperthyroidism
- Acromegaly
- Idiopathic anaphylaxis
Certain medications might also lead to hot flashes. They include:
- Depo leuprolide
- Clomiphene
- Tamoxifen
- Raloxifene
- Tricyclic antidepressants
- Monoamine oxidase inhibitors
- Calcium channel blockers
- Serotonin uptake inhibitors
- Chemotherapy
Hot flashes are a common side effect, affecting up to 80% of women taking tamoxifen, a cancer medication.
What to expect with Hot Flashes
The outlook for hot flashes is generally positive. In most cases, women find that their hot flashes go away within 5 years. However, it’s worth noting that around 10% of women might continue experiencing symptoms for up to 10 years.
Possible Complications When Diagnosed with Hot Flashes
Nighttime hot flashes can cause people to wake up, leading to long-term sleep disruption. Studies suggest that women who experience hot flashes may have a higher risk of heart disease and osteoporosis compared to women who do not have them.
Common Heat Flash Impacts:
- Interrupted sleep
- Increased risk of heart disease
- Increased risk of osteoporosis
Preventing Hot Flashes
Your primary care doctor or obstetrician and gynecologist (a doctor who specializes in women’s reproductive health) should be your first go-to for information. You can also find helpful educational resources on the websites of the American College of Obstetricians, the American Society of Reproductive Specialists, and the North American Menopause Society.
